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Assessment of the Dermatology Life Quality Index (DLQI) in a homogeneous population under lifetime arsenic exposure

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Abstract

Purpose

The psychometric property of the Dermatology Life Quality Index (DLQI) is underappreciated in public health settings. Our study aimed to assess the reliability, validity, and measurement invariance of DLQI in a homogeneous population with arsenic-related skin lesions and symptoms.

Methods

A cross-sectional study was conducted in communities under lifetime arsenic exposure. The DLQI was measured through a face-to-face interview. Skin examinations were performed by certificated dermatologists. The intensity of itching was measured by a numerical rating scale. Reliability, structural validity, and measurement invariance were determined using classical and modern test theories, including confirmatory factor analysis and item response models.

Results

465 participants with arsenic-related skin lesions and symptoms completed the DLQI assessment. The Cronbach’s alpha was 0.79, and the split-half reliability was 0.77. A two-factor model exhibited the best model fit among models evaluated, but local dependencies among items were identified. The model showed good root mean square error of approximation (0.031) and acceptable Tucker–Lewis index (0.92). Multi-group confirmatory factor analysis showed no measurement invariance across subgroups of age, gender, ethnicity, and intensity of itching.

Conclusions

The DLQI had acceptable psychometric properties, but measurement invariance was not observed across different groups of participants.

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References

  1. Zheng, Y., & Flanagan, S. V. (2017). The case for universal screening of private well water quality in the U.S. and testing requirements to achieve it: Evidence from arsenic. Environmental Health Perspectives, 125(8), 085002.

    Article  Google Scholar 

  2. Smith, A. H., & Steinmaus, C. M. (2009). Health effects of arsenic and chromium in drinking water: Recent human findings. Annual Review of Public Health, 30, 107–122.

    Article  Google Scholar 

  3. Arikan, I., Namdar, N. D., Kahraman, C., Dagci, M., & Ece, E. (2015). Assessment of arsenic levels in body samples and chronic exposure in people using water with a high concentration of arsenic: A field study in Kutahya. Asian Pacific Journal of Cancer Prevention, 16(8), 3183–3188.

    Article  Google Scholar 

  4. Tondel, M., Rahman, M., Magnuson, A., Chowdhury, I. A., Faruquee, M. H., & Ahmad, S. A. (1999). The relationship of arsenic levels in drinking water and the prevalence rate of skin lesions in Bangladesh. Environmental Health Perspectives, 107(9), 727–729.

    Article  CAS  Google Scholar 

  5. Committee on Toxicology. (2001). Arsenic in drinking water: 2001 update. Washington, D.C.: National Academies Press.

    Google Scholar 

  6. Ohnishi, K., Yoshida, H., Shigeno, K., et al. (2002). Arsenic trioxide therapy for relapsed or refractory Japanese patients with acute promyelocytic leukemia: need for careful electrocardiogram monitoring. Leukemia, 16(4), 617–622.

    Article  CAS  Google Scholar 

  7. Wang, Z., He, H., Yan, Y., & Wu, C. (1999). Arsenic exposure of residents in areas near Shimen arsenic mine. Journal of Hygiene Research, 28(1), 12–14.

    PubMed  Google Scholar 

  8. Hu, Y., Zhou, L., Li, X., et al. (2015). Arsenic contamination in Shimen Realgar Mine I: AS spatial distribution, chemical fractionations and leaching. Journal of Agro-Environment Science, 34(8), 1515–1521.

    CAS  Google Scholar 

  9. Namdar, N. D., Arikan, I., Kahraman, C., Kocaturk, E., Dagci, M., & Ece, E. (2017) Evaluation of the quality of life in patients with arsenic keratosis. Cutaneous and Ocular Toxicology, 37(2), 1–5.

    Google Scholar 

  10. Finlay, A. Y., & Khan, G. K. (1994). Dermatology Life Quality Index (DLQI)—A simple practical measure for routine clinical use. Journal of Clinical and Experimental Dermatology, 19(3), 210–216.

    Article  CAS  Google Scholar 

  11. Both, H., Essink-Bot, M. L., Busschbach, J., & Nijsten, T. (2007). Critical review of generic and dermatology-specific health-related quality of life instruments. Journal of Investigative Dermatology, 127(12), 272639.

    Article  Google Scholar 

  12. Liu, Y. L., Li, T., An, J. G., Zeng, W. H., & Xiao, S. X. (2016). Rasch analysis holds no brief for the use of the Dermatology Life Quality Index (DLQI) in Chinese neurodermatitis patients. Health and Quality of Life Outcomes, 14, 17.

    Article  Google Scholar 

  13. He, Z., Lu, C., Basra, M. K. A., Ou, A., Yan, Y., & Li, L. (2013). Psychometric properties of the Chinese version of Dermatology Life Quality Index (DLQI) in 851 Chinese patients with psoriasis. Journal of the European Academy of Dermatology and Venereology, 27(1), 109–115.

    Article  CAS  Google Scholar 

  14. Wang, K. Y., Wang, K. H., & Zhang, Z. P. (2011). Health-related quality of life and marital quality of vitiligo patients in China. Journal of the European Academy of Dermatology and Venereology, 25(4), 429–435.

    Article  Google Scholar 

  15. Wu, Y. Y., Fu, C. W., Zhang, W., Li, C. X., & Zhang, J. (2018). The Dermatology Life Quality Index (DLQI) and the hospital anxiety and depression (HADS) in Chinese rosacea patients. Psychology Health & Medicine, 23(4), 369–374.

    Article  Google Scholar 

  16. Brown, T. A. (2006). Confirmatory factor analysis for applied research. New York: The Guilford Press.

    Google Scholar 

  17. Reise, S. P., & Waller, N. G. (2009). Item response theory and clinical measurement. Annual Review of Clinical Psychology, 5, 27–48.

    Article  Google Scholar 

  18. Shen, M., Cui, Y., Hu, M., & Xu, L. (2017). Quantifying traditional Chinese medicine patterns using modern test theory: an example of functional constipation. BMC Complementary and Alternative Medicine, 17(1), 44.

    Article  Google Scholar 

  19. Du, W., & Xiao, H. (2012). Multidimensional grade response model. Acta Psychologica Sinica, 44(10), 1402–1407.

    Article  Google Scholar 

  20. Nijsten, T., Meads, D. M., de Korte, J., et al. (2007). Cross-cultural inequivalence of dermatology-specific health-related quality of life instruments in psoriasis patients. Journal of Investigative Dermatology, 127(10), 2315–2322.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank all coordinators and investigators that contributed to the field survey. We thank Dr. Shuiyuan Xiao for his expertise in revising the manuscript.

Funding

This work was supported by The Ministry of Science and Technology of China (2015FY111100).

Author information

Authors and Affiliations

  1. Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China

    Yi Xiao, Xiaoyan Huang, Danrong Jing, Yuzhou Huang, Juan Su, Jie Li, Jianglin Zhang, Mingliang Chen, Xiang Chen & Minxue Shen

  2. Hunan Engineering Research Center of Skin Health and Disease, Changsha, China

    Yi Xiao, Xiaoyan Huang, Danrong Jing, Yuzhou Huang, Juan Su, Jie Li, Jianglin Zhang, Mingliang Chen, Xiang Chen & Minxue Shen

  3. Hunan Key Laboratory of Skin Caner and Psoriasis, Changsha, China

    Yi Xiao, Xiaoyan Huang, Danrong Jing, Yuzhou Huang, Juan Su, Jie Li, Jianglin Zhang, Mingliang Chen, Xiang Chen & Minxue Shen

  4. Department of Social Medicine and Health Management, Xiangya School of Public Health, Changsha, China

    Xingyu Zhang

  5. Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China

    Zhihao Shu & Zhijun Huang

Authors
  1. Yi Xiao
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  2. Xiaoyan Huang
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  3. Danrong Jing
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  4. Yuzhou Huang
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  5. Xingyu Zhang
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  6. Zhihao Shu
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  7. Zhijun Huang
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  8. Juan Su
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  9. Jie Li
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  10. Jianglin Zhang
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  11. Mingliang Chen
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  12. Xiang Chen
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  13. Minxue Shen
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Contributions

YX, XH, DJ, YH, XZ, ZS, ZH, and MS, participated in the field survey. YX, XH, DJ, and YH performed the dermatological examinations. YX and MS analyzed the data and drafted the manuscript. ZH, JS, JL, JZ, MC, XC, and MS designed the study, critically reviewed, and revised the manuscript. XC obtained the funding. All authors gave final approval to the version submitted for publication.

Corresponding authors

Correspondence to Xiang Chen or Minxue Shen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was conducted according to the guidelines laid down in the Declaration of Helsinki. All procedures involving patients were approved by the institutional research ethics boards of Xiangya Hospital and The Third Xiangya Hospital, Central South University (Changsha, China).

Informed consent

Written informed consent was obtained from all participants.

Electronic supplementary material

Below is the link to the electronic supplementary material.

11136_2018_1969_MOESM1_ESM.tif

Scree plot of the exploratory factor analysis. Two common factors with eigenvalue>1.0 were identified. The third common factor had marginally significant eigenvalue of 0.99 (TIF 106 KB)

11136_2018_1969_MOESM2_ESM.tif

Item characteristic curve and item information function of the unidimensional item response model. The IRT was established for a unidimensional model. Each Item characteristic curve describes the item-specific relationship between the ability level (X-axis) and probability of endorsing a certain response (Y-axis). Black, blue, green, and magenta lines signify 0, 1, 2, and 3, respectively. Ability in the item response theory model practically (though not exclusively) ranged from −3 to +3. The dash lines signify item information functions, which indicate the precision of the items (TIF 253 KB)

11136_2018_1969_MOESM3_ESM.tif

Item characteristic curve and item information function of the bi-dimensional item response model. The IRT was established for a bi-dimensional model. Symbols are identical to Figure S2 (TIF 87 KB)

Supplementary material 4 (DOCX 18 KB)

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Cite this article

Xiao, Y., Huang, X., Jing, D. et al. Assessment of the Dermatology Life Quality Index (DLQI) in a homogeneous population under lifetime arsenic exposure. Qual Life Res 27, 3209–3215 (2018). https://doi.org/10.1007/s11136-018-1969-2

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  • DOI: https://doi.org/10.1007/s11136-018-1969-2

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